<script type="text/javascript" src="<?php echo base_url();?>assets/js/validation.js"></script>
<div id="lisregister" style="width:100%; margin-right: 0px">
    <div id="registerheader"> <label> Register </label> </div>
    <div class="formregister">
        <form action="<?php echo base_url();?>user/register" method="POST" onsubmit="return validateregistration(this)">
            <label>Entity</label>
            <select name="role_id" tabindex="1">
                <option value="1">Consignee</option>
                <option value="2">Shipping Line</option>
                <option value="3">Terminal Operator</option>
                <option value="4">Trucking</option>         
            </select><br/>
            <label>Name</label>
            <input type="text" id="name" name="name" tabindex="2" /><br/>
            <label>Address</label>
            <input type="text" id="address" name="address" tabindex="3" /><br/>
            <label>City</label>
            <input type="text" id="city" name="city" tabindex="4"/><br/>
            <label>Postal Code</label>
            <input type="text" id="postcode" name="postcode" tabindex="5"/><br/>
            <label>Telephone</label>
            <input type="text" id="telp" name="telp" tabindex="6"/><br/>
            <label>Handphone</label>
            <input type="text" id="hp" name="hp" tabindex="7"/><br/>
            <label>Fax</label>
            <input type="text" id="fax" name="fax" tabindex="8"/><br/>
            <label>Email</label>
            <input type="text" id="email" name="email" tabindex="9" /><br/>
            <label>Username</label>
            <input type="text" id="username" name="username" tabindex="10" onblur="return validateusername(this)"/><br/>
            <label>Password</label>
            <input type="password" id="passwords" name="passwords" tabindex="11"/><br/>
            <label>Confirm Password</label>
            <input type="password" id="confirmpassword" name="confirmpassword" tabindex="12"/><br/>
            <input id="formregisterbutton" type="submit" value="Submit"/>
        </form>
    </div>
</div>